Unit 1 - Decontamination of the Poisoned Patient Flashcards
What are the indications for ocular decontamination?
There was an irritant or corrosive chemical exposure: pH, key words on the bottle, if it causes burns to the skin
T/F: You should have owners start ocular decontamination at home
True
What are the best eye flushes to use for ocular decontamination?
Eye wash (best), tap water, and LRS or saline
What flush should be avoided for ocular decontamination?
Avoid eye drops
What does caution on a label signal/indicate?
Risk of significant illness/injury is low
Mild redness/irritation
What does danger on a label signal/indicate?
Risk of significant illness/injury is high
Alkaline pH of >11.5 or acid pH <2-3
If a label says the product is an ocular irritant, what may that mean for decontamination?
The owner may be able to perform it
Irrigation for 10-15 minutes
Monitor for signs of irritation
Symptomatic pets should be evaluated by DVM
What signs of irritation are associated with an ocular irritant?
Pawing or rubbing at the eye, redness, lacrimation, squinting, and swelling
If a label says the product is a corrosive, what may that mean for ocular decontamination and treatment?
The owner should attempt to irrigate at home for 15-20 minutes
Veterinarian should irrigate the eye for 15-20 minutes with eye wash
Fluorescein stain
Topical antibiotic ointment or drops
Elizabethan collar to prevent some trauma
Monitor for worsening signs
What are the indications for dermal decontamination?
Corrosives or irritants, systemically absorbed toxins, glues or adhesives, prevent oral exposure by self-grooming, remove unwanted substances, paresthesia, and burns
What decontamination methods should be used for a dermal irritant?
Rinse/bathe +/- topical vitamin E
What decontamination methods should be used for a dermal corrosive?
Rinse for 15 minutes, bathe with dish soap, and burn care
What are some systemic or orally absorbed toxins that can affect the dermis?
Tea tree oil, topical pain creams, estrogen creams, permethrin/pyrethrin (cats), psoriasis cream, and 5FU
How are systemic or orally absorbed toxins treated in cases of dermal contamination?
Bathe 2-3 times with a degreasing dish soap
Activated charcoal may be indicated
Blood work and supportive care will depend on the toxin type
How are glue/adhesive dermal contaminants decontaminated?
Loosen with oil, bathe, clip fur, and possible benign negligence
What is gasoline/hydrocarbons bad for the dermis?
Defatting the dermis, risk for aspirations, and Inhalation which causes CNS depression
How is dermal decontamination done for gasoline/hydrocarbons?
Bathe multiple times with degreasing dish soap and analgesics
What is the treatment for a first degree burn?
Lavage and topical therapy
What is the treatment for a second or third degree burn?
Debridement, silver sulfadiazine, analgesics, monitor for metabolic derangements
What are the indications for inhalation decontamination?
Concentrates or corrosives, smoke inhalation, and gas inhalation (chlorine, carbon monoxide, and natural
What is the decontamination method for a minor inhalation irritant?
fresh air
What does carbon monoxide do if inhaled?
Decrease the oxygen carrying capacity
What does thermal inhalation cause?
Edema, erosions, and ulcerations
What does inhalation of hydrogen cyanide cause?
cyanide toxicity
What is the treatment for inhalation toxicity in birds?
Remove from the source, humidified oxygen cage, heat support, and fluids
What are the options for GI decontamination?
Emesis, gastric lavage, activated charcoal, cathartics, whole bowel irrigation, and/or endoscopy and surgical removal
What are the indications for emesis?
Asymptomatic, foods, medications, large ingestions, rodenticides, small, dull foreign objects, and no breed or health risk
What are the contraindications for emesis?
Symptomatic, already vomited bile, history or risks of aspiration pneumonia, sharp/dangerous objects, corrosive agent, or hydrocarbons
What species do you want to avoid inducing emesis in?
rabbits, ruminants, horses, birds, and rodents (chincillas, rats, gerbils)
The best content recovery with emesis is within ____ minutes.
30
What toxicants are safe to induce emesis for up to 6 hours after ingestion?
Grapes/raisins, chocolate, gum, large plant ingestion, massive ingestion, and drugs that decrease gastric emptying
What drugs decrease gastric emptying?
Opioids, salicylates, anticholinergics, and tricyclic antidepressants
What can be used to induce emesis in dogs?
Apomorphine, hydrogen peroxide, and ropinirole (Clevor)
What does apomorphine do?
Stimulates dopamine-2 receptors in CRTZ
How can apomorphine be given?
IM, IV, and conjunctival administration
How is Ropinirole (Clevor) given?
Drops in the eye
What side effects are associated with Ropinirole (Clevor)?
Eye irritation, tachycardia, tachypnea, lethargy, ataxia, diarrhea, and tremors
When should you use caution when administering Ropinerole?
When dogs have ocular and/or cardiac disease
Ropinerole is not recommended for dogs that are what?
Pregnant or lactating
What is a potential negative side effect of using hydrogen peroxide to induce emesis?
mucosal lesions in the stomach
What can be used to induce emesis in cats?
Xylazine, dexmedetomidine, or hydromorphone
What are the cons to using xylazine and dexmedetomidine to induce emesis in cats?
The efficacy isn’t great, excessive sedation, and cardiovascular collapse
What are some inappropriate methods of inducing emesis?
Salt, syrup of ipecac, digital stimulation, and liquid dish soap
What are the pros to using activated charcoal?
It is readily available and relatively inexpensive
It is suspected to bind to most toxicants
It may decrease absorption by 25-30%
It can be administered with food
What are the cons to using activated charcoal?
The window for administration is unclear It can cause hypernatremia It is difficult to administer It is messy It can cause vomiting after administration It can cause diarrhea or changes to the stool It binds to therapeutic medications The benefit is unknown
When is activated charcoal contraindicated?
Neurologically inappropriate Dehydration Hypernatremia Hypovolemic shock Decreased GI motility/Ileus Recent surgery Protracted vomiting Inappropriate timeframe Ingestion of a caustic substance or hydrocarbon Endoscopy Abdominal surgery of the GIT Gastric or intestinal obstruction If there is a risk of aspiration pneumonia
What is the most rapid and potent cathartic used for decontamination?
Sorbitol - it is often combined with charcoal
What type of cathartic is sorbitol?
an osmotic cathartic
How does sorbitol work?
It has hygroscopic action resulting in increased water in the large intestine and increased intraluminal pressure which stimulates catharsis
What cathartic is useful for mild iron toxicity?
magnesium hydroxide
What side effects are associated with magnesium based cathartics?
Hypotonia, ECG changes, altered mental status, and respiratory failure
Why are magnesium based cathartics not recommended for bromethalin toxicity?
They may exacerbate or mimic toxicity signs
When is gastric lavage indicated?
In species that do not vomit
If there was an unsuccessful emesis attempt
If there is a large volume of stomach content
In symptomatic patients with a large ingestion
Potentially life-threatening toxin
What are the contraindications for gastric lavage?
Hydrocarbon ingestions, corrosives, recent surgery unstable patients, patients at higher risk for bleeding or injury, inappropriate time frame, or liquid toxins
What is the method for gastric lavage?
- Sedate, intubate, and ET inflation
- Lateral recumbency with the head tilted down at an approximately 20 degree angle
- Measure tube to the last rib
- Flush 5-10ml/kg warm water through a large-bore stomach tube
- Agitate stomach
- Aspirate or gravity drainage of stomach contents
- +/- Activated charcoal
What are the indications for whole bowel irrigation?
Iron intoxication, enteric coated drugs, sustained or ER formulations, and packets of drugs
What agent is used for whole bowel irrigation?
polyethylene glycol
When is endoscopy indicated?
For coins, non-leaking batteries, patches, bottles/plastic, other metals, and to evaluate for injury to the esophagus/stomach
When is surgery indicated?
Gorilla glue, sharp objects, large foreign bodies, medication bezoars, leaking batteries, large # of objects, +/- bread dough
What are the negatives to endoscopy or surgery decontamination?
May be delayed pending stability of the patient General anesthesia is required Cost Accessibility of equipment Operator skill-endoscopy
